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Abstract

Pembrolizumab is an effective anticancer immunotherapy. It is generally well tolerated although immune-related adverse events can occur. Autoimmune thyroid dysfunction is the most common one among these events. Several evidences suggested that pembrolizumab can induce thyroid dysfunction after several treatment cycles. The aim of the study is to evaluate the incidence and risk factors of thyroid function abnormalities related to pembrolizumab therapy.This is a multicenter prospective study including 100 patients with different cancers who initiated pembrolizumab treatment. Demographic data was collected in addition to the number of treatment cycles, history of thyroid surgery, thyroid disease, chemotherapy and steroid treatment. Baseline T3, T4 and TSH were measured and assessed periodically. Patients were distributed into 2 groups, those who maintained euthyroid state and the others who developed thyroid dysfunction. Assessment was analyzed looking for any relationship of this dysfunction with age, gender, dose, underlying diagnosis or previous disease or treatment lines.Thyroid dysfunction was reported in 31 patients (31%). Female patients were the predominant affected group, (P <0.001). Intriguingly, 38.75% of patients with euthyroidism were ex/current smokers compared with 19.35% of patients with thyroid dysfunction (P <0.028). The median number of pembrolizumab cycles in patients with euthyroidism and with thyroid dysfunction was 5.0 and 6.5, respectively (P <0.028). Finally, the presence of thyroid disease was more frequent among patients with thyroid dysfunction than those with euthyroidism (P <0.005).Conclusions: A considerable proportion of patients receiving pembrolizumab can develop thyroid dysfunction. Female gender, number of treatment cycles and history of thyroid disease may be risk factors for thyroid dysfunction in those patients.

DOI

10.52573/ipmj.2023.180594

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